1986, 09-29 Permit App: 00013333 FurnaceMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
I certify that the above information as submitted by me is true and correct and further, agree that all pro-
visions of laws and ordinances governing this type of work, including inspection requirements, will be com-
plied with whether specified herein or not. The granting of a permit does not presume to give authority to
violate or cancel the provisions of any state of local laws regulating construction or the performance of
construction.
SIGNATURE OF ��jj
OWNER OR /4" --At Ai Li/
APPLICATION
DATE %/ i
%9 ron
Project" / 3533
Owner's Name . Last First MI
Project Address (Street Name & Number
fel IC"a. s�. \VO1 RL)
City `1�I C-eeencuLLa4
State
Subtlivision/Plat Name
Assessors Parcel pc) -1 .C7� - �7� /-
LotLi,
Block/
Plat p A s
Applicant
Address
City
State
Zip
Phone
Business Phone
Contractor
Address
City
Stale
Zip
Phone
Contact
Licensell
Business Phone
Describe Work
Fans
Evaporative Cooler
Hoods
Electric Furnace/Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water Htr.
Solid Fuel/ Wood Stove
Air Handling Units
0.10,000 CFM
10,000+ CFM
Refrigeration Systems/
Heat Pumps (BTU)
1-100M
101-500M
501-1,000M
1,001-1750M
Over 1750M
Compressor
0-3HP
3-15HP
15-30HP
30-50HP
504 -HP
Gas Piping
1-5 Outlets
6+ Outlets
Gas Fired Heating System
1-100,000BTLL
10.4.00+ BTU
I certify that the above information as submitted by me is true and correct and further, agree that all pro-
visions of laws and ordinances governing this type of work, including inspection requirements, will be com-
plied with whether specified herein or not. The granting of a permit does not presume to give authority to
violate or cancel the provisions of any state of local laws regulating construction or the performance of
construction.
SIGNATURE OF ��jj
OWNER OR /4" --At Ai Li/
APPLICATION
DATE %/ i
%9 ron